Health Management Technology asked select industry experts to respond to the following question:

What are the best ways to minimize the pains associated with selecting and adopting a clinical information system?

Cloud-based systems offer easier EHR deployment Oleg Bess, M.D., CEO, 4medica The best strategy to minimize troubles associated with migrating from paper to electronic records is to choose an EHR that fi ts a hospital’s precise needs and aligns with the level of their clinical, fi nancial and IT resources. For example, small- and medium-

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size facilities are better off with a secure cloud-based subscrip- tion service (SaaS) EHR solution than an enterprise system. A SaaS application can be deployed rapidly in weeks rather than months or years because it leverages the Internet net- work and standard industry protocols in conjunction with the hospital’s current IT infrastructure. Clinicians already familiar with how to use a Web browser fi nd a cloud EHR easy to learn and use from the start. SaaS also costs 50 to 66 percent less, since it doesn’t require hospitals to incur big upfront infrastructure, hardware and software investments, as the vendor operates, maintains and upgrades the infrastructure and EHR remotely.

In contrast, enterprise EHRs typically are proprietary sys- tems specifi cally built to address the needs of large academic medical centers and hospitals. They require at least a year to be deployed and cost over $1 million. Unlike larger peers, smaller facilities lack the nurse and physician informaticists, deep pockets and IT personnel necessary to customize, sup- port and evolve an enterprise EHR.

An EHR that may be right for one hospital may not be right for another. Organizations that take their size, budget and clinical and technical resources into account when select- ing a system will have easier implementations; those that fail or adopt a one-size-fi ts-all EHR will have a rockier ride.

Select a system that meets MU, functionality and business requirements Paul Pitcher, research director, KLAS In March 2011, the KLAS “Community Hospital EMRs Maturing for Meaningful Use” report found that 20 percent of community hospitals are looking for a new EMR. Mean- ingful use (MU) is a primary concern for hospitals seeking a new CIS, both from a system functionality standpoint as well as a physician buy-in perspective for CPOE adoption. One CEO said, “The frustration is with the physician docu- mentation. We know that any physician EMR is going to be troubling for the doctors because they don’t really want to take the time to document.” KLAS has found that providers aim to select a system that meets MU, functionality and business requirements, as well as provides a workfl ow conducive to existing clinician workfl ow. Hospitals also take additional steps to give them the best chance for deep CPOE adoption: • Involve key shareholders. Physicians, nurses and other shareholders should be involved in the selection process from the very beginning, providing feedback on solutions. Some hospitals even allow their shareholders to vote on the selection and then involve them in the system build.

• Get executive buy-in. Executive involvement and ap- proval of a CIS will percolate down the organization to encourage buy-in from the rest of the organization.

• Solid implementation, go-live support and training. Implementations should include clear communication of timelines and potential delays to manage clinician expectations. In addition, ensuring that there is thorough training and a large support staff to resolve issues eases the transition to the new CIS and improves chances for CPOE adoption.